title: Complicated parapneumonic effusions in children caused by penicillin-nonsusceptible Streptococcus pneumoniae.
abstract: OBJECTIVE
  To describe the clinical characteristics of complicated parapneumonic effusions (CPE) in children caused by Streptococcus pneumoniae nonsusceptible to penicillin (PCN-N) and compare their clinical outcome with CPE caused by penicillin-susceptible (PCN-S) organisms.
  
  
  METHODS
  Children with parapneumonic effusions were identified retrospectively between July 1992 and June 1996. Charts of patients with CPE were reviewed for data obtained at the time of hospital admission. In addition, outpatient charts and/or the families of children with CPE caused by PCN-N S pneumoniae were reviewed to identify specific risk factors associated with PCN-N organisms.
  
  
  RESULTS
  Sixty-four cases of CPE were identified during the 4-year period. In 26 cases a bacterial pathogen was recovered, with S pneumoniae accounting for 23 of these isolates (88%). Of the 23 S pneumoniae cases, 17 were PCN-S and 6 cases were nonsusceptible. Complicated parapneumonic effusions caused by PCN-N S pneumoniae occurred in significantly younger patients than CPE that were PCN-S (2.1 years vs 7.9 years). Nonsusceptible effusions also had a higher incidence of bacteremia than PCN-S effusions (100% vs 29%). There were no significant differences between the two groups for duration of chest tube drainage, febrile days, oxygen use, and hospital stay.
  
  
  CONCLUSIONS
  CPE caused by PCN-N S pneumoniae is associated with a younger age and higher rate of bacteremia than CPE caused by PCN-S strains. However, there were no significant differences in outcome measures between patients infected with susceptible or nonsusceptible organisms.
authors.affiliation: Division of Pulmonary Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: Hardie
authors.forename: N E
authors.initials: NE
authors.lastname: Roberts
authors.forename: S F
authors.initials: SF
authors.lastname: Reising
authors.forename: C D
authors.initials: CD
authors.lastname: Christie
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016470:Bacteremia / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010403:Penicillin Resistance; D010996:Pleural Effusion / Q000382:microbiology* / Q000503:physiopathology; D011018:Pneumonia, Pneumococcal / Q000150:complications*; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects